Hospital practice (1995)
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An 80-year-old man presented with subjective fever, chronic cough occasionally producing scant yellow sputum, retrosternal pleuritic pain, and dyspnea on walking one block. Since symptom onset three months earlier, he had lost 20 pounds; he had had two loose stools a day, fatigue, malaise, and anorexia but not hemoptysis, nausea, vomiting, hematemesis, hematochezia, or melena. ⋯ As far as could be ascertained, he not recently been exposed to tuberculosis or any other infectious disease. He had previously been seen at another clinic and had completed a 10-day trial of erythromycin (500 mg p.o. q12 h) without apparent change in symptoms.
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A 40-year-old woman who had experienced recurring episodes of dyspnea for 28 years presented to the emergency department with increasing shortness of breath, wheezing, and dry cough of three days' duration. She had been seen at another hospital shortly after symptoms began but left against medical advice. She did not have fever, chills, or other symptoms of upper respiratory infection.
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Insomnia is common, but the causes are so diverse that careful evaluation is needed to ensure selection of effective treatment. Duration is the most important guide to intervention. ⋯ Drugs for patients who require long-term therapy should be selected to minimize side effects. Long-acting drugs should be used with caution in the elderly.